Effects of thiamine on cardiac function in patients with systolic heart failure: Systematic review and metaanalysis of randomized, double-blind, placebo-controlled trials

Background: Thiamine is an important micronutrient, and thiamine deficiency is prevalent in patients with congestive heart failure. Methods: Using Ovid MEDLINE, PubMed, and Excepta Medica (Embase),we conducted a systematic reviewand metaanalysis of randomized, double-blind, placebo-controlled trials of thiamine supplementation in patients with congestive heart failure. Results: Compared with placebo (2 trials, n=38), thiamine supplementation resulted in a significantly improved net change in left ventricular ejection fraction (LVEF) (3.28%, 95% confidence interval [CI]: 0.64%, 5.93%). Conclusion: Compared against placebo, thiamine supplementation in 2 randomized, double-blind trials resulted in a significant improvement in net change in LVEF. While further trials are required to establish thiamine's role in patients with systolic heart failure, thiamine may help to improve LVEF in these patients

Clopidogrel is safer than ticagrelor in regard to bleeds: A closer look at the PLATO trial

Objective: To compare hemorrhagic events between clopidogrel and ticagrelor in the Platelet Inhibition and Patient Outcomes (PLATO) trial. Methods: We examined the FDA Medical Review. Results: Compared to clopidogrel, ticagrelor significantly increased spontaneous bleeds, major bleeds, major plus minor bleeds, and major plus minor plus minimal bleeds. Ticagrelor also increased both major and fatal/life-threatening bleeds versus clopidogrel when CABG was performed between 24 and 96 h after stopping medication, which was also accompanied by a larger volume of chest tube drainage and transfusions. Moreover, ticagrelor increased CABG-related bleeding versus clopidogrel in those patients who did not wait until day 5 after stopping treatment to have CABG. Additionally, compared to clopidogrel, ticagrelor increased the risk of hematuria (RR = 1.91; 95% CI: 0.95-3.83), intracranial hemorrhage or subdural or other hematoma (RR 1.87; 95% CI: 1.02-3.42), subcutaneous hemorrhage, ecchymosis, hematoma (RR = 1.63; 95% CI: 0.84-3.17), epistaxis (RR = 1.49; 95% CI: 0.67-3.32), retroperitoneal hematoma or hemorrhage (RR = 1.49; 95% CI: 0.53-4.19), gastrointestinal/anal bleed (RR = 1.23; 95% CI: 0.93-1.64) and bleed/hematoma (RR = 1.21, 95% CI: 1.02-1.43). Conclusions: Clopidogrel is safer than ticagrelor in regard to bleeding. Additionally, ticagrelor's purported faster antiplatelet 'offset' is substantially longer than its pharmacokinetics indicate. Considering the fact that the mortality, stent thrombosis and myocardial infarction 'benefit' of ticagrelor have recently been challenged, and that the increase in stroke on ticagrelor has recently been shown to be worse than originally published, the decision to use ticagrelor over clopidogrel in the face of a higher risk for bleeds is not advised. (C) 2013 Elsevier Ireland Ltd. All rights reserved

L-carnitine for the treatment of acute myocardial infarction

Although the therapeutic strategies available for treating acute myocardial infarction (AMI) have evolved dramatically in recent decades, coronary artery disease remains the leading cause of death in our society, and the rates of recurrent myocardial infarction and mortality are still unacceptably high. Therefore, exploration of alternative therapeutic strategies for AMI is of utmost importance. One such strategy is to target metabolic pathways via L-carnitine supplementation. L-carnitine is a physiologically essential metabolic cofactor that has been shown to provide a plethora of benefits when administered after AMI. L-carnitine has been shown to lessen infarct size, to reduce ventricular arrhythmias, left ventricular dilation, and heart failure incidence, as well as improve survival. These benefits may, in part, be related to its ability to boost glucose oxidation in ischemic tissues, while moderating increases in fatty acyl-coenzyme A levels that can impair mitochondrial efficiency and promote oxidative stress and inflammation. This article summarizes the evidence pertinent to the therapeutic use of L-carnitine for AMI

Dietary Sodium Restriction: Take It with a Grain of Salt

The American Heart Association recently strongly recommended a dietary sodium intake o

β-Blockers in hypertension, diabetes, heart failure and acute myocardial infarction: a review of the literature

β-Blockers (BBs) are an essential class of cardiovascular medications for reducing morbidity and mortality in patients with heart failure (HF). However, a large body of data indicates that BBs should not be used as first-line therapy for hypertension (HTN). Additionally, new data have questioned the role of BBs in the treatment of stable coronary heart disease (CHD). However, these trials mainly tested the non-vasodilating β1 selective BBs (atenolol and metoprolol) which are still the most commonly prescribed BBs in the USA. Newer generation BBs, such as the vasodilating BBs carvedilol and nebivolol, have been shown not only to be better tolerated than non-vasodilating BBs, but also these agents do not increase the risk of diabetes mellitus (DM), atherogenic dyslipidaemia or weight gain. Moreover, carvedilol has the most evidence for reducing morbidity and mortality in patients with HF and those who have experienced an acute myocardial infarction (AMI). This review discusses the cornerstone clinical trials that have tested BBs in the settings of HTN, HF and AMI. Large randomised trials in the settings of HTN, DM and stable CHD are still needed to establish the role of BBs in these diseases, as well as to determine whether vasodilating BBs are exempt from the disadvantages of non-vasodilating BBs

Optimal aspirin dose in acute coronary syndromes: An emerging consensus

ABSTRACT:  Numerous clinical trials testing the efficacy of aspirin for the secondary prevention of cardiovascular disease have been published. We reviewed the literature pertaining to aspirin dose in acute coronary syndrome patients. Clinical trials assessing the comparative efficacy of different doses of aspirin are scarce. This complex antiplatelet therapy landscape makes it difficult to identify the best aspirin dose for optimizing efficacy and minimizing risk of adverse events, while complying with the various guidelines and recommendations. Despite this fact, current evidence suggests that aspirin doses of 75–100 mg/day may offer the optimal benefit:risk ratio in acute coronary syndrome patients. </jats:p